To evaluate the effect of microvascular invasion (MVI) and surgical margin on postoperative survival and prognosis of hepatocellular carcinoma (HCC) patients.

Clinical data of 513 patients with HCC admitted to the First People's Hospital of Foshan from January 2016 to December 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 419 patients were male and 94 female, aged from 25 to 86 years, with a median age of 54 years. MVI was divided into three grades: M0 (non-MVI group), M1 (low-risk group) and M2 (high-risk group). The tumor surgical margin was divided into narrow surgical margin (<1 cm) and wide surgical margin (≥1 cm). The influencing factors of MVI in HCC patients were identified by Chi-square test and Logistic regression analysis. Survival analysis was conducted by Kaplan-Meier method and Log-rank test.

Univariate analysis showed that AFP, tumor diameter, number of tumors and China liver cancer (CNLC) staging system were correlated with the incidence of MVI in HCC patients (χ²=28.068, 29.657, 4.375, 10.208; P<0.05). Multivariate Logistic regression analysis showed that AFP and tumor diameter were the independent influencing factors of MVI in HCC patients (OR=0.408, 0.394; P<0.05). In the M0 group, the postoperative 1-,2- and 3-year disease-free survival rates were 79.6%, 71.0% and 63.4%, and 59.6%, 48.0% and 43.3% in the M1 group, and 31.0%, 27.5% and 25.2% in theM2 group, respectively. The differences were statistically significant (χ²=61.889, P<0.05). In the M0 group, the postoperative 1-, 2- and 3-year overall survival rates were 97.3%, 88.2% and 84.6%, 87.0%, 71.5% and 66.1% in the M1 group, and 79.3%, 61.9% and 52.6% in the M2 group, respectively. The differences were statistically significant (χ²=44.138, P<0.05). For MVI-negative patients, the postoperative 1-,2- and 3-year disease-free survival rates in the wide margin group were 82.6%, 70.7% and 65.4%, and 79.4%, 64.7% and 60.5% in the narrow margin group, with no statistical significance (χ²=0.983, P>0.05). In the wide margin group, the 1-, 2- and 3-year overall survival rates were 97.5%, 89.6% and 85.2%, and 97.1%, 86.0% and 82.8% in the narrow margin group, with no statistical significance (χ²=0.051, P>0.05). For MVI-positive patients, the postoperative 1-, 2- and 3-year disease-free survival rates in the wide margin group were 58.1%, 45.4% and 40.3%, and 42.9%, 37.3% and 36.1% in the narrow margin group. The differences were statistically significant (χ²=4.874, P<0.05). In the wide margin group, the postoperative 1-, 2- and 3-year overall survival rates were 88.8%, 71.9% and 64.3%, and 82.6%, 64.8% and 61.0% in the narrow margin group. The differences were statistically significant (χ²=4.604, P<0.05).

Tumor size and AFP are the independent risk factors for MVI in HCC patients. The higher the MVI grade, the worse the prognosis. For patients with positive MVI, long-term prognosis of patients with wide surgical margin is better than that of those with narrow surgical margin. However, for patients with negative MVI, tumor surgical margin exerts no significant effect upon clinical prognosis.